Long-distance Caregiving

Your mother has fallen a couple of times, or your dad frequently forgets to take his medicine. You wish you could be there to help, but you live across the country and have your own responsibilities.

Many Americans find themselves in that situation. About 6.7 million of us provide care to a family member who lives an hour or more away, according to a 2004 National Caregiver Survey by the National Alliance for Caregiving and AARP.

While it can be frustrating to be so far away, that doesn’t mean you have to be out of the loop. You can still develop a plan of action to help your parent (or other relative) be safe and comfortable as he or she gets older. Be sure to start planning early, before a crisis or emergency forces you to act. And don’t be surprised if you encounter some resistance.

“You need to have an open discussion with your parent about his or her daily needs along with other family members,” says Elizabeth Clark, executive director of the National Association of Social Workers (www.helpstartshere.org).

Brian Carpenter, associate professor of psychology specializing in geropsychology at Washington University in St. Louis, says it is important to “impress upon your parent that you and the rest of the family want to help out of a sense of love and caring, not obligation.”

Develop a Support Network

As you devise a plan, bring in others to form a support network. They can include family members who live nearby, friends, neighbors, church or synagogue acquaintances, or even a trusted building superintendent, says Marion Somers, a geriatric care manager and author of “Elder Care Made Easier: Doctor Marion’s 10 Steps to Help You Care for an Aging Loved One” (Addicus Books, 2006). You should work out a schedule so that someone is checking in with your parent regularly, and that person should stay in contact with you by telephone or e-mail.

Show your appreciation to people you are asking to help out. “Make a donation to their favorite charity or send them a goodie basket at the holidays,” Somers says.

If you’re considering further steps—like an assessment from a geriatric care manager or ongoing home care—ask your parent’s doctor to explain how such services can allow him or her to remain at home safely and comfortably. The physician might also suggest consulting with a care manager, occupational therapist, social worker, or psychologist.

Carpenter recommends that you speak with the doctor regularly to stay current on medical issues and changes in your parent’s condition. The doctor will need your parent’s permission to talk to you about personal health matters, so discuss this with him or her as well.

Make Use of Technology

Even if you’re hundreds of miles away, you can be part of your parent’s support network through the help of technology. For an initial outlay of about $2,000, plus $30 a month for broadband Internet access, Mike Willner, 51, of Lorton, Va., videoconferences with his parents, Kurt, 84, and Joyce, 81, who live in Wakefield, R.I. This is done through a Webcam that is hooked up to his parents’ computer and installed above a flat-panel television set. Mike subscribes to a service that allows him to control his parents’ computer from his own. When he wants to talk with them, he makes a video call.

“It makes me feel like I’m sitting right there with them, and they get a kick out of it,” he says. “I can see if everything looks OK in their home.”

Other technological tools, including monitoring devices and services, can alert you if your parent has an emergency.

Get a Handle on Finances

You can also monitor a parent’s financial affairs long-distance. Have yourself or another family member added as a cosigner on your parent’s checking account, advises Carolyn McClanahan, president of Life Planning Partners in Jacksonville, Fla., and a board member of the National Association of Personal Financial Advisors (www.napfa.org), which represents fee-only planners.

Regular monthly expenses, such as utilities and mortgage or rent, can be automatically paid from your parent’s checking account to minimize the number of checks that have to be written.

If your parent can no longer manage paying bills, you can arrange to have them sent directly to you (or another family member). Be sure to look over any credit-card bills for signs of fraudulent activity. You might want to set up an online bank account for your parent that you can also access to monitor cash flow and arrange for bills to be paid.

You should review your parent’s overall finances to make sure that his or her investments are appropriate and can generate sufficient income to meet expenses. If your parent agrees, you might want to consult with a financial planner. To avoid potential conflicts of interest, use a fee-only planner, who charges a set hourly rate and doesn’t receive commissions on the financial products he or she recommends.

A planner can develop a comprehensive financial plan in 5 to 20 hours, depending on the complexity of your parent’s investment portfolio, McClanahan says. Most fee-only planners charge $100 to $250 an hour, plus a additional fee—usually 1 percent of assets—if they manage a portfolio on an ongoing basis, she adds.

Bring in a Geriatric Care Manager

If it seems that your parent’s daily needs go beyond your support network and you’re not sure what to do, it might be time to call in a geriatric care manager, usually a nurse or social worker. Seek information and referrals from local Area Agencies on Aging. For help finding an agency nearby, go to www.n4a.org.

You can also check the Web site of the National Association of Professional Geriatric Care Managers, at www.napgcm.org. The association’s 2,200 members must have one of four approved certifications—CMC (Care Manager Certified), CCM (Certified Case Manager), C-SWCM (Certified Social Work Case Manager), and C-ASWCM (Certified Advanced Social Work Case Manager). They also must follow a code of ethics, says Monika White, the organization’s president. Look for someone who has at least three years’ experience with clients needing the same types of services as your parents, and ask for three references, she says.

The care manager should first meet with your parent at home. You can be there, but it’s not always necessary. Probably the first thing the care manager will do is assess your parent’s overall health and ability to perform daily activities. He or she will then determine if your parent’s home requires any physical accommodations, like grab bars or ramps. The care manger will provide referrals, and arrange for any in-home services your parent needs.

Financial resources will be assessed to determine your parent’s or family’s ability to pay for services. The care manager might evaluate insurance coverage, help with claims, or make referrals to a financial planner or an elder-law attorney.

An initial assessment will cost $300 to $800. Ongoing care-management services are $80 to $200 an hour, depending on the region, White says. Or, if appropriate, you might be charged a monthly fee for ongoing services.

Put the Right Services in Place

If your parent needs help with medications or activities of daily living such as bathing, dressing, and preparing meals, it’s probably time to consider a home health aide. A care manager can determine how many hours a week your parent needs one, and whether the aide should also help with light housekeeping, shopping trips, or doctor appointments.

The aide will be employed by a homecare agency, and you should be involved in selecting the agency as well as the employee who will care for your parent. Make sure the agency you choose does background checks and trains its employees.

Agencies vary in the types of services they provide. Besides routine tasks, for example, some will help your parent deal with natural disasters. “We have had our caregivers go to shelters with their clients during hurricanes,” says Richard Bitner, national marketing director for Visiting Angels Living Assistance Services, a homecare agency with 340 offices nationwide.

Home care generally costs from $15 an hour for basic assistance to $150 an hour for care management or skilled nursing care. You’ll be asked to sign a contract with the agency for the services your parent will receive. Just make sure you can cancel at any time and for any reason.

Keep a support network in place, and ask friends and family members to make regular visits and report back to you on the quality of care your parent is receiving. You should also visit occasionally yourself—maybe drop in unannounced—so that you can see how everything is working out.

Keep in mind that you can never be sure a parent is 100 percent covered. “Something can happen even if you’re sitting right next to them,” Somers says. “All you can do is your best.”